Abstract

A soft tissue repair method. The method includes providing a flaccid tubular member having a longitudinal bore and first and second ends, the tubular member defining first and second portions integral with the tubular member. The method includes coupling the tubular member to a flexible strand, inserting the tubular member from a first side of the soft tissue to a second side of soft tissue, such that a first portion of the tubular member exits the second side of the soft tissue and a second portion of the tubular member remains inside the soft tissue, tensioning the flexible strand, deforming the first portion of the tubular member to an anchoring shape, and forming a vascularization conduit from the second portion of the tubular member.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent application Ser. No. 11/347,661 filed Feb. 2, 2006 and a continuation-in-part Ser. No. 11/408282 filed on Apr. 20, 2006. This application claims the benefit of U.S. Provisional Application No. 60/885,062, filed on Jan. 16, 2007, and U.S. Provisional Application No. 60/885,057, filed on Jan. 16, 2007. The disclosures of the above applications are incorporated herein by reference.

INTRODUCTION

Tears caused by trauma or disease in soft tissue, such as cartilage, ligament, or muscle, can be repaired by suturing and/or use of various fixation devices. Various tissue fixation devices have been developed for facilitating suturing and are effective for their intended purposes.

The present teachings provide a soft tissue repair method. The method includes providing a flaccid tubular member having a longitudinal bore and first and second ends, the tubular member defining first and second portions integral with the tubular member. The method includes coupling the tubular member to a flexible strand, inserting the tubular member from a first side of the soft tissue to a second side of soft tissue such that a first portion of the tubular member exits the second side of the soft tissue and a second portion of the tubular member remains inside the soft tissue, tensioning the flexible strand, deforming the first portion of the tubular member to an anchoring shape, and forming a vascularization conduit from the second portion of the tubular member.

In another aspect, the soft tissue repair method includes inserting a flaccidly deformable tubular member through a meniscus, the tubular member having first and second portions, traversing a meniscal defect with the second portion, and anchoring the tubular member to an outer surface of the meniscus with the first portion of the tubular member.

In a further aspect, the soft tissue repair method includes passing a shaft of an inserter through a longitudinal bore of a flaccidly deformable tubular member, inserting the deformable tubular member axially through soft tissue until a first portion of the tubular member is outside an outer surface of the soft tissue and a remaining portion extends axially inside the soft tissue, and deforming the first portion into an anchor on the outer surface of the soft tissue.

Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present teachings will become more fully understood from the detailed description and the accompanying drawings, wherein:

FIG. 1 is a perspective view of a flexible tubular member coupled to a flexible strand according to the present teachings, the tubular member shown with a first portion deformed;

FIG. 2A is an environmental side view illustrating a flexible tubular member loaded on an inserter for insertion through soft tissue;

FIG. 2B is an environmental side view illustrating a flexible tubular member inserted through soft tissue such that a first portion of the tubular member is outside an outer surface of the soft tissue;

FIG. 2C is an environmental side view illustrating tensioning a flexible strand to deform the first portion of the tubular member;

FIG. 2D is an environmental side view illustrating further tensioning a flexible strand to form an anchor from the first portion of the tubular member;

FIG. 2E is an environmental side view illustrating tensioning a flexible strand to deform the first portion of the tubular member;

FIG. 2F is an environmental side view illustrating further tensioning of the flexible strand of FIG. 2D to form an anchor from the first portion of the tubular member;

FIG. 3 is a perspective view of an inserter according to the present teachings; and

FIG. 4 is a perspective view of a flexible tubular member loaded on the inserter of FIG. 3.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses. For example, although the present teachings are illustrated in an application for meniscus repair in knee surgery, the present teachings can also be used for repairing any fibrous tissue, such as muscle, ligament or tendon in an arthroscopic or other open procedure, including rotator cuff reconstruction, acromioclavicular (AC) reconstruction, anterior cruciate ligament reconstruction (ACL) and generally for fastening tendons, grafts, or strands to fibrous tissue and bone. Additionally, the present teachings can be used for repairing tissue in cardiological, laparoscopic, urological, plastic or other procedures.

An exemplary soft tissue repair device 101 according to the present teachings is illustrated in FIG. 1. The repair device 101 can include an elongated flexible member 100 in the form of a flaccid and deformable hollow sleeve or tubular member with a longitudinal inner bore 106 and first and second ends 108, 110. The repair device 101 can also include an elongated flexible strand 200, such as a suture, coupled to the flexible member 100. The flexible strand 200 can have first and second ends 220, 222.

The flexible member 100 can be made of resorbable or non-resorbable materials, including braided suture, woven/braided from biocompatible materials or fibers, such as, for example, polymer, polyester, polyethylene, cotton, silk, harvested vascular structures, or other natural or synthetic materials. The flexible member 100 can have any properties that allow the flexible member 100 to change shape or deform. The flexible member 100 can be, for example, compliant, flexible, foldable, squashable, squeezable, deformable, limp, flaccid, elastic, low-modulus, soft, spongy, perforated or any other flexible member which can change shape.

In some aspects, the flexible member 100 can be coated with biological or biocompatible coatings, and it can also be soaked in platelets and other biologics, which can be easily absorbed by the flexible member 100 in particular when, for example, the flexible member 100 is made from spongy, absorbent material. It should be understood by the above description that the flexible member 100 cannot pierce or otherwise penetrate tissue either with the first and second ends 108, 110 or with any portion thereof. The strand member 200 can be made of braided filaments or fibers of biocompatible material, including natural and synthetic fibers, such as cotton, silk, polymer, polyester, polyethylene, suture, and other materials.

Referring to FIGS. 3 and 4, the flexible member 100 can be loaded on the external surface of an inserter 300. The inserter 300 can include a shaft portion 302 and pointed or sharp tip 304. The inserter 300 can pass through the longitudinal inner bore 106 of the flexible member 100, as shown in FIG. 4, for guiding the flexible member 100 through soft tissue. Other inserters can also be used, such as, for example, the inserters described in the above cross-referenced and incorporated by reference patent applications, for example. The inserter 300 can include an external longitudinal guiding groove 302 for guiding a portion of the strand member 200.

The strand member 200 can be coupled to the flexible member 100 such that tensioning the strand member 200 by pulling on a free end 220 of the strand member 200 causes a first portion 102 of the flexible member to deform to a U-shape, as shown in FIG. 2C. Further tensioning of the strand member 200 causes the first portion 102 to deform to a bulkier, bunched-up, ball-like shape or anchoring shape that can serve as an anchor outside soft tissue 80, as shown in FIG. 2D and discussed below. The anchoring shape of the first portion 102 has a width W1 that is greater that the width W2 of the second portion 104 and of the opening formed in the tissue by the introduction of the flexible member 100 into the tissue 80, and prevents the first portion 102 of the flexible member 100 from re-entering the soft tissue and be pulled through the incision, thereby anchoring the flexible member 100 to the soft tissue 80. The remaining second portion 104 of the flexible member 100 can remain elongated with a substantially straight or curved or tortuous shape that forms a vascularization conduit bridging a soft tissue defect 82, and/or providing a vascularization path between vascular and avascular portions of the soft tissue 80, as discussed below.

An exemplary aspect of coupling the strand member 200 to the flexible member 100 to deform the first portion 102 is illustrated in FIG. 1, after partial tensioning. The strand member 200 can define intersecting and reducible-length loops 203, 205 passing through the inner bore 106 of the flexible member 100 and having external segments 202, 204. The first external segment 202 can extend outside the bore 106 from openings 230, 232 of the flexible member 100. The second external segment 204 can extend outside the bore 106 from an opening 234 to the opening at the second end 110 of the flexible member 100. The first end 220 of the strand member 200 can exit through the opening of the first end 106 of the flexible member 100, and the second end 222 of the strand member 200 can be coupled to the first external segment 202 with a slip knot 206. Tensioning the strand member 200 by pulling the first end 220 of the strand member 200 can reduce the length the external segments 202, 204 and associated strand loops 203, 205 allowing the first portion 102 to deform to the shape shown in FIG. 2D. A third segment 208 of the strand member 200 can extend through the inner bore 106 along the second portion 104 from an opening 236 to the opening of the first end 108 of the flexible member 100.

An alternative aspect of coupling the strand member 200 to the flexible member 100 to deform the first portion 102 is illustrated in FIGS. 2E-F. In this aspect, the second external segment 204 can extend between the first and second ends 108, 110 of the flexible member 100. Tensioning the strand member 220 can cause some curving of the second portion 104, as shown in FIG. 2F.

The soft tissue repair device 101 can be used to repair a soft tissue defect 82, such as, for example, a tear, or other weakness in fibrous soft tissue 80, such as in meniscal tissue, cartilage, muscle or other fibrous tissue under the skin. In the exemplary illustration of FIGS. 2A-2D, the soft-tissue repair assembly 100 is illustrated for meniscal repair and vascularization. The second portion 104 of the flexible member can serve as a conduit between vascular and avascular regions of the meniscus on opposite sides of the defect 82 for conducting native or endogenous biological materials between first and second areas of the tissue, such as, for example, between healthy tissue and injured or torn tissue, or between areas of different vascularity, such as between red-red (vascular), red-white (semi-vascular) and white (avascular) tissue areas of a meniscus. The second portion 104 can provide a vascularity path in the soft tissue 80 for facilitating healing or repair. Additionally, biological materials in the form of platelet gels can be deposited in the flexible member 100 before implantation, as another mechanism of biological material delivery, including nutrient material delivery.

The first portion 102 of the flexible member 100 can serve as an anchor implanted on an outer surface 84 of the soft tissue 80. The implanted shape of the first portion 102 of the flexible member 102 can be of a bulkier or ball-like shape with length to width ratio close to one, as illustrated in FIG. 2D, for snugly securing the flexible member 100 on the outer surface of the soft tissue 80. The implanted shape of the first portion 102 can have bigger overall width or enclosed cross-sectional area or volume than the second portion 104 such that the first portion 102 cannot be pulled out of the same opening through which it was originally inserted. The first portion 102 can retain its bulkier shape after implantation, even after the tension on the strand portion 106 is removed.

Referring to FIGS. 2A-2D, the repair device 101 can be loaded on the inserter 300 and passed from a first surface 86 of the soft tissue 80 through the defect 82 and again through the tissue 80 until the first portion 102 of the flexible member 100 is outside a second surface 84 of the soft tissue 80 in a substantially elongated (straight or curved) configuration, as shown in FIG. 2B. Tensioning the strand member 200 by pulling in the direction of arrow A, deforms the first portion 102 into its anchor-like bulkier shape, as shown in FIGS. 2C and 2D. The second portion 104 can remain elongated (straight or curved) and form a vascularization conduit for the soft tissue 80.

It will be appreciated that multiple soft tissue repair devices 101 can be used by repeating the above procedure for repairing a soft tissue defect as described in the patent applications cross-referenced above. The present teachings provide an easy to use and effective method for repairing soft tissue with an integral device that provides anchoring and vascularization upon implantation.

The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the present teachings as defined in the following claims.

Claims (20)

1. A soft tissue repair method comprising:

providing a flaccid tubular member having a longitudinal bore, and first and second ends, the tubular member defining first and second portions integral with the tubular member;

coupling the tubular member to a flexible strand;

inserting the tubular member from a first side of the soft tissue to a second side of soft tissue, such that a first portion of the tubular member exits the second side of the soft tissue and a second portion of the tubular member remains inside the soft tissue;

tensioning the flexible strand;

deforming the first portion of the tubular member to an anchoring shape; and

forming a vascularization conduit from the second portion of the tubular member.

2. The method of claim 1, wherein coupling the tubular member to a flexible strand includes:

passing the flexible strand through the second portion of the tubular member; and

forming a strand loop through the first portion of the tubular member.

3. The method of claim 1, wherein the anchoring shape is a ball-like shape.

4. The method of claim 1, wherein the vascularization conduit is elongated.

5. The method of claim 1, further comprising loading the tubular member on an inserter.

6. The method of claim 5, wherein loading the tubular member on an inserter includes passing the inserter through the longitudinal bore of the tubular member.

7. The method of claim 1, further comprising traversing a soft tissue defect with the vascularization conduit.

8. The method of claim 1, further comprising bridging vascular and avascular portions of the soft tissue with the vascularization conduit.

9. The method of claim 1, wherein tensioning the flexible strand includes reducing a length of a loop formed by the flexible strand through the first portion of the tubular member.

10. A soft tissue repair method comprising:

inserting a flaccidly deformable tubular member through a meniscus, the tubular member having first and second portions;

traversing a meniscal defect with the second portion; and

anchoring the tubular member to an outer surface of the meniscus with the first portion of the tubular member.

11. The method of claim 10, wherein anchoring the tubular member to an outer surface of the meniscus with the first portion of the tubular member includes deforming the first portion of the tubular member to an anchoring shape.

12. The method of claim 11, wherein deforming the first portion of the tubular member to an anchoring shape includes tensioning a flexible strand, the flexible strand forming a loop of reducible length through the first portion.

13. The method of claim 10, wherein traversing the meniscal defect with the second portion includes forming a vascularization conduit between opposing sides of the meniscal defect.

14. The method of claim 10, wherein traversing the meniscal defect with the second portion includes creating a vascularization path between vascular and avascular portions of the meniscus.

15. A soft tissue repair method comprising:

passing a shaft of an inserter through a longitudinal bore of a flaccidly deformable tubular member;

inserting the deformable tubular member axially through soft tissue until a first portion of the tubular member is outside an outer surface of the soft tissue and a remaining portion of the tubular member extends axially inside the soft tissue; and

deforming the first portion into an anchor on the outer surface of the soft tissue.

16. The method of claim 15, wherein deforming the first portion into an anchor on the outer surface of the soft tissue includes reducing a length of flexible strand looped around the first portion.

17. The method of claim 16, wherein reducing the length of flexible strand looped around the first portion includes tensioning the flexible strand.

18. The method of claim 15, further comprising forming a vascularization path through the soft tissue with the remaining portion.

19. The method of claim 15, wherein forming the vascularization path includes bridging vascular and avascular regions of the soft tissue with the remaining portion,

20. The method of claim 15 wherein forming the vascularization path includes traversing a soft tissue defect with the remaining portion.

Sternum closure comprises pairs of plates with L-shaped cross-section positioned on inner surface of sternum and plates with C-shaped cross-section on its outer surface, plates being fastened together by pins passing through them